Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that involves a

decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when
the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and
block the upper airway. This leads to partial reductions (hypopneas) and complete pauses
(apneas) in breathing that last at least 10 seconds during sleep. Most pauses last between
10 and 30 seconds, but some may persist for one minute or longer. This can lead to
abrupt reductions in blood oxygen saturation, with oxygen levels falling as much as 40
percent or more in severe cases.
The brain responds to the lack of oxygen by alerting the body, causing a brief arousal
from sleep that restores normal breathing. This pattern can occur hundreds of times in
one night. The result is a fragmented quality of sleep that often produces an excessive
level of daytime sleepiness.
Most people with OSA snore loudly and frequently, with periods of silence when airflow
is reduced or blocked. They then make choking, snorting or gasping sounds when their
airway reopens.
A common measurement of sleep apnea is the apnea-hypopnea index (AHI). This is an
average that represents the combined number of apneas and hypopneas that occur per
hour of sleep.

Prevalence

OSA can occur in any ager group, but prevalence increases between middle and
older age.
OSA with resulting daytime sleepiness occurs in at least four percent of men and
two percent of women
About 24 percent of men and nine percent of women have the breathing
symptoms of OSA with or without daytime sleepiness.
About 80 percent to 90 percent of adults with OSA remain undiagnosed.
OSA occurs in about two percent of children and is most common at preschool
ages.



Types

Mild OSA: AHI of 5-15
Involuntary sleepiness during activities that require little attention, such as
watching TV or reading
Moderate OSA: AHI of 15-30
Involuntary sleepiness during activities that require some attention, such as
meetings or presentations
Severe OSA: AHI of more than 30
Involuntary sleepiness during activities that require more active attention, such as
talking or driving

Risk groups
People who are overweight (Body Mass Index of 25 to 29.9) and obese (Body
Mass Index of 30 and above)
Men and women with large neck sizes: 17 inches or more for men, 16 inches or
more for women
Middle-aged and older men, and post-menopausal women
Ethnic minorities
People with abnormalities of the bony and soft tissue structure of the head and
neck
Adults and children with Down Syndrome
Children with large tonsils and adenoids
Anyone who has a family member with OSA
People with endocrine disorders such as Acromegaly and Hypothyroidism
Smokers
Those suffering from nocturnal nasal congestion due to abnormal morphology,
rhinitis or both.

Effects
Fluctuating oxygen levels
Increased heart rate
Chronic elevation in daytime blood pressure
Increased risk of stroke
Higher rate of death due to heart disease
Impaired glucose tolerance and insulin resistance
Impaired concentration
Mood changes
Increased risk of being involved in a deadly motor vehicle accident
Disturbed sleep of the bed partner

Treatments

Sleep apnea must first be diagnosed at a sleep center or lab during an overnight sleep study,
or polysomnogram. The sleep study charts vital signs such as brain waves, heart beat and
breathing.

Continuous positive airway pressure (CPAP):
CPAP is the standard treatment option for moderate to severe cases of OSA and a
good option for mild sleep apnea. First introduced for the treatment of sleep apnea in
1981, CPAP provides a steady stream of pressurized air to patients through a mask
that they wear during sleep. This airflow keeps the airway open, preventing pauses in
breathing and restoring normal oxygen levels. Newer CPAP models are small, light
and virtually silent. Patients can choose from numerous mask sizes and styles to
achieve a good fit. Heated humidifiers that connect to CPAP units contribute to
patient comfort.

Oral appliances:
An oral appliance is an effective treatment option for people with mild to moderate
OSA who either prefer it to CPAP or are unable to successfully comply with CPAP
therapy. Oral appliances look much like sports mouth guards, and they help maintain
an open and unobstructed airway by repositioning or stabilizing the lower jaw,
tongue, soft palate or uvula. Some are designed specifically for snoring, and others
are intended to treat both snoring and sleep apnea. They should always be fitted by
dentists who are trained in sleep medicine.
Surgery: Surgery is a treatment option for OSA when noninvasive treatments such
as CPAP or oral appliances have been unsuccessful. It is most effective when there is
an obvious anatomic deformity that can be corrected to alleviate the breathing
problem. Otherwise, surgical options most often address the problem by reducing or
removing tissue from the soft palate, uvula, tonsils, adenoids or tongue. More
complex surgery may be performed to adjust craniofacial bone structures. Surgical
options may require multiple operations, and positive results may not be permanent.
One of the most common surgical methods is uvulopalatopharyngoplasty (UPPP),
which trims the size of the soft palate and may involve the removal of the tonsils and
uvula. Adenotonsillectomy, the surgical removal of the tonsils and adenoids, is the
most common treatment option for children with OSA. Other children with sleep
apnea may benefit from CPAP.

Behavioral changes:
Weight loss benefits many people with sleep apnea, and changing from back-
sleeping to side-sleeping may help those with mild cases of OSA.

Over-the-counter remedies:
Although some external nasal dilator strips, internal nasal dilators, and lubricant
sprays may reduce snoring, there is no evidence that they help treat OSA. They may
even mask the problem by muting the loud snoring that is a warning sign for sleep
apnea.
Position Therapy:
A treatment used for patients suffering from mild OSA. Patients are advised to stay
off of the back while sleeping and raise the head of the bed to reduce symptoms.


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